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Home My WebLink About0066 ELAINE ROAD - Health 19 Elaine Road Hyannis A= 248-106 f i 1 I o � I TOWN OF BARNSTABLE if-, tj n- l 9 LOCATION !_[ . ��Ct 1�c IGV SEWAGE # / ` Vd.LAGE ASSESSOR'S MAP& LOT Ay9-.M6 INSTALLER'S NAME&PHONE NO. r �C 7 7S s ( SEPTIC TANK CAPACY �OOU C�• C>Xl S( 0 IT LL ,,,, LEACHING FACILITY: (type) �_ (� � (size) � �/ Pf Sl0`T r NO.OF BEDROOMS (9- l 1C S fn f BUILDER OR OWNER PERMITDATE: ?1 F-1 c) COMPLIANCE DATE: Separation Distance Between the: 1 Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 110 C l 0( Feet Private Water Supply Well and Leaching Facility (If any wells exist ,�9 on site or within 200 feet of leaching facility) l"d� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 fe t of leaching fC Feet Furnished by r� CA d �T i No. 1 r� Fee THE COMMONWEALTH OF MASSACHUSETTS V/ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSE S . 01ppYication for Oigooar bpgtem Construction Verna Application is hereby made for a Permit to Construct( )or Repair(ian On-site Sewage Disposal System at: Location Address or Lot No. 1 i wner's Name,Address and jel.No. Assessor's Map/Parcel 10" „ 19Gc. c Installer's Name,Address,and Tel.No. CfA Designer's Name,Address and Tel.No. Qvr_F (:Z C Type of Building: Dwelling No.of Bedrooms _ Garbage Grinder AX Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the En ' mental Co e an 7itlt'to-place the system in operation until a Certifi- cate of Compliance has been iss a by this Board o Health. Signed Date %/ . Application Approved by Date Application Disapproved for the following reasons Permit No. (.41 Date Issued No: n y Fee�L J THrCOMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS . i ZppYication for Migpogal bpgtem Congtruction Permit 1 Application is hereby made for a Permit to Construct( )or Repair((4an On-site Sewage Disposal System at: Location Address or Lot No. ICE Owner's Name,Address and Tel.No. 1 Assessor's Map/Parcel Installer's Name,Address,and Tel No. Designer's Name,Address and Tel.No. Type of Building: � 1 Dwelling No.of Bedrooms Garbage Grinder( J0 1 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil j Nature of Repairs or Alterations•(Answer when applicable) ( Ge ;,y41a� E r 1 4 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Env' a t-to-place the system in operation until a' e,�rtifi- cat e�of Compliance has been iss by this Board o Heal Signed Date / Application Approved by Date ,r Application Disapproved for the following reasons Permit No. 42 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of.Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced( P/on by C .-�d, t Installer Ma GIC Ca at `J C _ has been constructed in accordance with the prov§ions of Ti e 5 and the for isposai System Construction Permit No. dated Date Inspector THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. --------------------------------------- - No. ffcn !!n Fee- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mfgpooar &pztem Construction Permit Permission is hereby granted to SCUD�k "L✓�-� `r G.S c to construct( )repair( cW On-site Sewage System located at No.#— ( Street and as described in the above Application for Disposal System Construction Permit. No. ate The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction ipust be completed within three years of the date below. Date: c Approved by L- Board of Health J CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, n" ``�cY.(1L hereby certify that the application for disposal works construction permit signed by me dated 2Z5"z2c,- , concerning the property located at Cj �4„�.�� y�,�n,. S meets all of the following criteria: There are no wetlands within 300 feet of the proposed septic system .•r There are no private wells within 150 feet of the proposed septic system znhe jobserved groundwater table is 14 feet or greater below the bottom of the leaching facility There is no increase in flow and/or change in use proposed •Where are no variances requested or needed. k r x SIGNED: �' DATE: . 1 ` LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. r' Ez :A(SL ,y